Mid-Career Transition

It's not unusual for physicians to enter hospice and palliative medicine (HPM) fellowship after spending some time as an attending. As you consider whether fellowship training is right for you, it's worth knowing that "mid-career" entry options exist. Currently there are two primary models: "standard" or "competency-based" fellowships. 

"Standard" HPM Fellowships

Going back to fellowship can be financially and emotionally challenging. It can be hard to live like a resident again. Nevertheless, many physicians have traveled this path and are glad they did. Many fellowship programs appreciate the "seasoned" applicant.

"Competency-Based" HPM Fellowships

Recently, the ACGME has piloted a new model for fellowship training designed for mid-career physicians. Rather than being a defined one-year time period, the length of fellowship varies according to how long it takes the trainee to develop competency in the core skills of the specialty. In this model, the fellow continues their full-time job and uses a percentage of their time to do the fellowship (usually 20%). The fellow develops an individualized learning plan and is assessed frequently to determine how much more training is required to develop competence.

Currently, this model is being investigated as a pilot at 7 programs and the pilot is expected to complete in 2025. If it is evaluated favorably, it may be an option in the future, but this is not guaranteed.

Tips for Those Considering a Mid-Career Entry into HPM

Confirm Your Interest

Arrange in-person shadowing experiences to gain practical insight and explore post-fellowship HPM career options. Evaluate your financial readiness for a year on a fellowship salary and consider salaries in your intended clinical setting after fellowship.

Seek Mentorship

Seek mentorship from mid-career EM physicians who have made the transition to HPM. Professional societies like SAEM, AAEM, and ACEP offer good opportunities to expand your network.

Embrace EM & HPM Professional Involvement

Demonstrate your commitment by volunteering to become your Emergency Department's primary palliative care and HPM champion. Lead primary palliative care quality improvement initiatives and educational efforts in your department. Engage in scholarly activities such as delivering lectures, contributing to society position statements, and participating in research or QI projects.

Research HPM Fellowship Programs

Determine if they have previously accepted EM-trained physicians and explore the support they offer for transitioning back to an EM-HPM lifestyle post-fellowship.

Consider Specialized Pathways

Explore specialized pathways like the University of Colorado Anschutz Medical Campus’s Community Hospice and Palliative Medicine (CHPM) Fellowship, designed for mid-career providers. Similar to the mid-career fellowship option, this program integrates online and distance learning. 

Inform Your Leadership Early

Communicate your aspirations and plans to your EM Chair or Medical Director as early as possible. Transparent communication prevents straining professional relationships during the application process. Some programs may require a department chair letter of recommendation as part of your application.

Highlight Your Unique Value

Emphasize your extensive experience as a mid-career physician. Showcase your ability to care for diverse patients, proficiency in goals-of-care conversations, and expertise in palliative procedures. Highlight your role in educating residents, students, and peers in primary palliative care principles. Your wealth of experience is a substantial asset.